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Can the NHS cut costs without substantially damaging the quality of health care? Yes

BMJ 2010; 340 doi: (Published 14 April 2010) Cite this as: BMJ 2010;340:c1999
  1. Paul Corrigan, management consultant and former director of commissioning, NHS London
  1. 1London
  1. corriganpauld{at}

    Rebecca Rosen (doi: 10.1136/bmj.c1967) and Paul Corrigan think that the NHS cost cutting that will occur over the next few years does not inevitably mean that the quality of care it provides will suffer. John Appleby (doi: 10.1136/bmj.c1959) and James Owen Drife (doi: 10.1136/bmj.c1966) are not so sure

    The NHS spends £100bn (€113bn; $153bn; 2009 figures) a year. It spends this money through a series of financial relationships, some of which are contractual or organisational ones, such as those between commissioners and providers. Other financial relationships are between individuals and organisations, such as contracts with medical staff.

    This money flows round the system through these relationships, and we can develop them to gain better value for money. In 2010 we are well placed to use incentives to improve health outputs without increasing resources.

    In a pre-reformed NHS one of the abiding ways in which inefficiency was incentivised was that if a hospital ran …

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